浅谈现代教育技术与医学继续教育

目的探讨现代教育技术对医学继续教育的地位和作用,从而提高医学继续教育质量。方法对现代教育技术和医学继续教育的概念、目的、方法等进行归纳总结,并结合我院情况加以阐述,来说明现代教育技术对医学继续教育的意义。结果现代教育技术是医学继续教育的一种工具,是医学继续教育的一种资源,为医学继续教育构造各种教学环境。结论现代教育技术在医学继续教育中的应用,是医学继续教育未来的发展方向。     

混合均一化法对复方丹参提取物质量控制的研究

目的探索研究复方丹参提取物质量控制技术。方法在多元指纹图谱质量控制标准下,运用批次混合均一化法,实现复方丹参提取物质量稳定均一化。结果多批次复方丹参提取物混合后质量明显改善,与标准提取物之间的指纹图谱相似度大于0.9,指标性成分量相对偏差小于0.03。结论批次混合均一化可保证复方提取物质量,为中药生产过程实现指纹图谱质量控制提供了新思路。     

大面积脑梗死32例死因分析

[目的]探讨大面积脑梗死的死因及治疗措施。[方法]回顾性分析32例大面积脑梗死死亡病例的临床资料。[结果]32例大面积脑梗死死亡病例中，老年人28例，占89．6％。非老年人4例，占10．4％。死于脑水肿、脑疝18例，死于肺部感染7例，死于多脏器功能衰竭4例。[结论]大面积脑梗死以老年人多见，脑疝和肺部感染为主要致死因素，因此，积极控制脑水肿、预防脑疝发生、有效地预防肺部感染是减少死亡率的关键。     

Suppressed spontaneous secretion of growth hormone in girls after treatment for acute lymphoblastic leukaemia.

The spontaneous secretion of growth hormone during a 24 hour period and the response of growth hormone to growth hormone releasing hormone was studied in 13 girls who had received treatment for acute lymphoblastic leukemia that included cranial irradiation with 20-24 Gy in 12-14 fractions. At the time of investigation the girls were at varying stages of puberty and had normal concentrations of thyroid hormones. The mean interval between the end of treatment and investigation was 4.6 years. The mean age at onset of the disease was 3.2 years and at investigation 10.7 years. The average attained height equalled -0.3 SD at onset, and -1.0 SD at the time of investigation. Secretion of growth hormone was substantially reduced compared with controls and did not increase during puberty. A prompt rise in growth hormone secretion was seen after injection of growth hormone releasing hormone, but the mean maximum growth hormone concentration was, however, only 25 mU/l. There was no correlation between the 24 hour secretion and growth hormone response to growth hormone releasing hormone, or the time since irradiation. These results confirm earlier work that suggested that girls who had received treatment for acute lymphoblastic leukaemia, that included cranial irradiation, have a comparative growth hormone insufficiency characterised by normal prepubertal growth and slow growth during puberty because of an inability to respond to the increased demands for growth hormone at that time.     

Anaplastic renal cell carcinoma following neuroblastoma

Renal cell carcinoma is unusual in children. We report a case of anaplastic renal cell carcinoma arising in a 7-year-old girl following treatment for Stage III neuroblastoma. The renal cell carcinoma has unusual histologic and ultrastructural features, which are discussed. The case is further unusual in that few children with advanced stage neuroblastoma survive long enough to develop second malignant neoplasms. © 1995 Wiley-Liss, Inc.     

肾血管平滑肌脂肪瘤21例

复习报告２１例肾血管平滑肌脂肪瘤（ＡＭＬ）的临床资料。年龄３１～７０岁（平均４４．５岁）。常见症状为腰、腹疼痛、包块、血尿、发热。２例有典型结节性硬化病的征象。临床上主要依据Ｂ超和ＣＴ检查诊断肾ＡＭＬ。资料表明，Ｂ超结合ＣＴ检查使术前诊断的准确性明显提高。肾ＡＭＬ常表现为Ｂ超强回声和ＣＴ低密度影团块。本组１１例行肾切除，但７例行保肾手术，３例随访，治疗效果同样良好。由于术前能诊断，肾ＡＭＬ的治疗趋向采用保肾手术或随访观察。     

A prospective study of microbial infection in stillbirths and early neonatal death

No morphologic cause of death was found in 67.8% of 33 perinatal deaths. The mothers had experienced a previous loss in 48% of cases. Inflammation occurred in 65.6% of the cases of perinatal death compared to 4% of a control group (p less than 0.001) and in 73.1% of organism-positive cases of perinatal death compared to 7.1% of organism-positive cases of the control group (p less than 0.001). Incidence of maternal fever or prolonged membrane rupture was not statistically significant. Bacteria were present in 33.3% of the cases of perinatal death (not significant), with more pathogenic strains occurring in this group (p = 0.0028); 75.0% had inflammation compared to 0% of the control group (not significant). Genital mycoplasmas were detected in 78.8% of cases of perinatal death compared to 32.3% of control cases (p less than 0.001). Positive cultures (p = 0.0142) and elevated antibody titers in the fetus or neonate (p = 0.00052) or in the mother (p = 0.0122) occurred significantly more often than in control cases. Inflammation occurred in 78.9% of mycoplasma cases (p = 0.00032); incidences of maternal fever and prolonged membrane rupture were not significantly different. In perinatal death cases 20% had evidence of viruses, and 3.2% had evidence of chlamydia. Evidence of mixed microorganisms occurred in 46% of cases of perinatal death. However, 78.6% (11 of 14) with only one organism had Ureaplasma urealyticum (33.3% overall). Of the Ureaplasma-positive cases, 72.7% had inflammation, 45.5% had fever, and only 18.2% had prolonged membrane rupture compared to 28.6%, 0%, and 16.6%, respectively, in a negative-microorganism group with perinatal deaths. Our observations strongly support the concept that infection is a major cause of perinatal death and that genital mycoplasmas play a significant role.     

Polymerase chain reaction for detection of Mycobacterium tuberculosis in epiretinal membrane in Eales' disease

PURPOSE: Tuberculous etiology has been suggested in Eales' disease. Because epiretinal membrane (ERM) is formed on the inner surface of the retina in Eales' disease, it could be the most appropriate intraocular specimen for investigation. Therefore, a nested polymerase chain reaction (nPCR), which detects MPB64 gene of Mycobacterium tuberculosis on the archival specimens of ERM of well-documented Eales' and non-Eales' patients, was applied and the results compared. METHODS: nPCR technique was standardized, and the sensitivity and specificity of the primers were determined. nPCR technique was applied to tissue sections obtained from formalin-fixed and paraffin-embedded tissues of ERM from 23 patients with Eales' disease and 27 noninfective and non-Eales' disease patients as controls. RESULTS: nPCR technique was specific for M. tuberculosis genome and sensitive enough to detect 0.25 fg (corresponding to the presence of a single bacillus). Eleven (47.8%) ERM of 23 Eales' disease and 3 (11.1%) of 27 controls were positive for M. tuberculosis genome. The difference between the two groups was statistically significant (P = 0.001), indicating association of this bacterium with Eales' disease. CONCLUSIONS: The demonstration of the presence of M. tuberculosis DNA by nPCR technique in significant number of ERM of Eales' disease compared with the controls further emphasizes the probable role of this bacterium in the pathogenesis of this enigmatic clinical condition.     

CXC chemokine GRO is essential for neutrophil infiltration in LPS-induced uveitis in rabbits

The purpose of this study was to investigate the role and regulation of the CXC chemokine GRO and the interaction between GRO and IL-8 in LPS-induced uveitis in rabbits. Uveitis was induced by intravitreal injection of 100 ng of LPS in rabbits. After the LPS injection, GRO was produced in aqueous humor and peaked at 24 hr. Immunohistochemistry showed that ciliary epithelial cells were responsible for production of GRO. Blocking the activity of GRO by anti-GRO serum reduced LPS-induced aqueous neutrophil counts by 80%, but did not reduce the mononuclear cell counts or protein levels or IL-8 levels. Regulation of GRO production by TNFalpha, IL-1 and IL-8 was studied. Anti-TNFalphamAb alone did not inhibit the 24 hr LPS induced GRO levels, whereas rrIL-1Ra inhibited the GRO production by 58%. The combination of anti-TNFalpha mAb and rrIL-1Ra inhibited 93% of GRO production. Although treatment with anti-IL-8 IgG inhibited the neutrophil infiltration by 66%, treatment with this antibody did not inhibit GRO production.Taken together, our results suggest that GRO is an essential mediator for neutrophil infiltration in LPS-induced uveitis in rabbits. Most of GRO production is mediated by TNFalpha and IL-1. GRO and IL-8 act in concert to mediate neutrophil infiltration.